Individual
MR. EVAN D THARALDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BA LADC
Contact information
Practice address
1246 UNIVERSITY AVE W, SAINT PAUL, MN 55104-4125
(651) 333-4368
(651) 666-2914
Mailing address
1246 UNIVERSITY AVE W, SAINT PAUL, MN 55104-4125
(651) 333-4368
(651) 666-2914
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
304577
MN
Other
Enumeration date
11/19/2020
Last updated
11/19/2020
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